A change in structure, not a change in existence

Clumsy title, I know.  The key point is that the most recent version of Paul Ryan's Medicare reform doesn't kill Medicare, it reforms it.  And the reform is using competition not a panel of experts to try keep costs down.

It is also true that the maximum growth for Medicare, whether we're talking Obama's plan of IPAB keeping the costs down (through cutting things Medicare will pay for, or changing the reimbursement rate) or Ryan's plan of using competitive bidding (for Medicare Pt. A), of GDP growth + 0.5%.

Whether either of them could actually keep the growth that low, given political pressure, who knows.